Inspection find short staffing contributed to Iowa nursing home death
For the second time in a month, a Story City nursing home has been cited for inadequate staffing, with the latest violation resulting in a death.
State inspectors allege that the Bethany Life care facility failed to provide staff to supervise a resident who needed assistance while eating, resulting in the man choking to death March 25 while eating in the home’s dining room.
Four weeks before the death, the home’s director of nursing had reportedly told state inspectors that while some areas of the home were not fully staffed, she was not concerned with either the staffing levels or resident supervision.
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According to the Iowa Department of Inspections and Appeals, the man who died had been eating lunch in the Bethany Life dining room three weeks after his admission to the facility when a licensed practical nurse saw him coughing and his face turning blue.
The man appeared to be choking on a caramel brownie, according to state reports. Several staff members attempted the Heimlich maneuver to clear his airway, but without success.
“Due to the consistency of the dessert, the staff couldn’t clear the resident’s airway,” inspectors later reported. “This resulted in his death.”
Slow response to call lights also reported
The man was known to eat too fast and to have difficulty swallowing, and his care plan called for additional supervision with verbal cues to be given advising him to eat slowly. The man’s widow told inspectors she had informed the Bethany Life staff several times that her husband needed to be watched at all times while eating.
State inspectors said the home “failed to supervise a resident who needed cues to slow down while eating and provide adequate staff for supervision,” resulting in the death. In addition, inspectors cited Bethany Life for failing to document the man’s death in his clinical record until after the state inspection was underway two weeks later.
Inspectors alleged that while they were in the facility observing the care being provided, the staff took up to 43 minutes to respond to residents’ call lights. One resident told inspectors that when her husband, who also resided at the home, fell to the floor, no one responded to the call light and she was unable to find any staff in the unit. She had to leave the area and was calling out “Woo hoo!!” when a nurse working in another area heard her and responded.
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According to data from the Centers for Medicare and Medicaid Services, 14% of Iowa’s 422 nursing facilities were cited for insufficient staffing in fiscal year 2023. That was more than double the national average for 2023, which was 5.9%.
Only five other states ― Hawaii, Michigan, Montana, New Mexico and Oregon — had a worse record of compliance with the sufficient-staffing requirement. Iowa neighbors Nebraska, South Dakota, Wisconsin and Missouri had no more than 2% to 6.8% of their facilities cited for insufficient staffing in 2023.
State: Employees fear retaliation
During their most recent visit to Bethany Life, state inspectors also reported that workers at the home said they were fearful of being fired if they reported concerns they had with the quality of care in the home. Based on those claims, the facility was cited for failing to ensure there was a process in place for the staff to report concerns in good faith without fear of retaliation.
The citation for failing to provide a safe environment for residents — the one tied to the man who choked to death — resulted in a proposed state fine of $9,250. Because it was a repeat violation ― having been previously cited on March 4 ― the proposed penalty was tripled to $27,750 and then held in suspension so that federal officials can determine whether to impose a federal fine in place of the state penalty.
During a previous inspection of the home that concluded three weeks before the man’s death, Bethany Life employees allegedly told inspectors the 15-resident dementia unit was often short-staffed. Two certified nursing assistants complained of being scheduled to work with only a medication aide to assist them rather than the expected registered nurse, medication aide, another CNA and a housekeeper.
One of the CNAs reportedly said that had the unit been fully staffed, the facility could have prevented a resident’s fall and subsequent hospitalization. The director of nursing acknowledged the unit was not fully staffed but told inspectors staffing was not a concern. The staffing issue resulted in a $7,000 fine.
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At the time, the home was also fined $500 for each of two abuse-related violations. One of the incidents involved a nurse manager overhearing a male CNA telling a resident, “Trust me, you don’t want to p— me off,” and a housekeeper observing the same CNA get in a resident’s face while yelling, “Shut up! Shut up! Shut the f— up!”
According to inspectors, the administrator was unable to provide video of the incidents despite the home’s use of cameras because video footage is routinely deleted at the end of each day.
The second abuse violation related to the facility’s alleged failure to adequately investigate five incidents of reported abuse. One of the five cases involved a staff member who allegedly offered sexual favors to a male resident with severe dementia, and another involved some unspecified form of abuse allegedly committed by an overnight worker.
Bethany Life has about 125 residents. Currently, CMS states the facility has a four-star rating on a five-star scale for its staffing levels.
The home’s nonprofit owner, Bethany Manor, reported a $2.1 million deficit on its 2022 tax returns. The same year, the organization reported two of its highest-paid workers were a certified nurse aide, at $137,421, and a medication aide at $118,771. Both employees worked an average of 40 hours per week, according to the organization’s tax returns.
Bethany Manor CEO Kim Schilling said Friday she was not able to respond immediately to questions about the organization’s finances and recent inspections.
Find this story atIowa Capital Dispatch, which is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Iowa Capital Dispatch maintains editorial independence. Contact Editor Kathie Obradovich for questions:[email protected].
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